NHS waiting lists are the longest on record, key NHS targets have not been met for several years, and there is a recruitment and retention crisis with over 100,000 staff vacancies.
Labour leader Keir Starmer was therefore justified to say, when making his speech in Essex today: “I don’t think the NHS survives another five years of Tory government… at the next election, the NHS is on the line.”
Starmer’s message was not just that Labour would save the NHS – “the cavalry is coming” he told his audience – but how: “we will reform the NHS”.
If Starmer was tough on Tory failure, he was also tough on the NHS: “The NHS is not sustainable unless we make serious, deep long-term changes.” A briefing note sent to Labour MPs states: “We cannot continue to pour money into a system that is not designed for the 21st Century.”
Reform was not used as a byword for marketisation and private providers though. It was about three quite functional shifts in how the wider health system operates: moving care away from hospitals and into communities; more emphasis on prevention; and more new technology – “a tomorrow service, not just a today service,” Starmer said, excruciatingly.
As well as pledging to meet NHS targets, Starmer set out three new targets: to reduce heart attacks and strokes by a quarter within a decade; to make sure 75 per cent of all cancer is diagnosed at stage one or two; and to reduce the suicide rate – “the biggest killer of young lives in this country”.
Sure, all of these pledges sound like the right direction. But the speech – as has become commonplace with Starmer – was heavy on soundbites, light on detail and positively homeopathic on funding.
As journalist after journalist tried to pin Starmer down on costs, the Labour leader ducked and dived like Floyd Mayweather, bobbing and weaving to avoid any need to talk about taxation or additional funding.
In the staged one-question-per-journalist, with no follow-ups, Starmer was able to evade scrutiny, but that’s rather like fighting an opponent with one arm strapped to their body.
Starmer rightly said, “Like any opposition, we will set out our plans before the election”. No one was expecting a fully costed spreadsheet today but, again, Starmer seems unable to make the argument for redistributive taxation. Social justice cannot be delivered with soundbites. It needs paying for. People know that, and Starmer should make the case that the wealthiest will pay more for the modern, first-class NHS he envisions.
Starmer, to be fair, offered some numbers around his mental health plans to “guarantee treatment inside four weeks for anyone who needs it”. He said that the 8,500 new mental health advisers would be paid for by scrapping tax loopholes for private equity fund managers. That’s a tribute to the relentless campaigning by Labour’s shadow mental health minister Dr Rosena Allin-Khan – who has won the respect of the sector.
But there are glaring contradictions. Starmer said “we’re committed to the biggest expansion of NHS training in its history… fully-funded by removing the non-dom tax status”.
However that doesn’t pay for then recruiting people into the NHS, paying their wages and pensions, let alone funding any pay rise, when low pay is a major factor pushing nurses, healthcare assistants and paramedics out of the NHS.
In his earlier media round, Starmer had said: “The money you need for the NHS will only realistically come if we’re able to grow the economy.”
Given Starmer has already pledged he will deliver the fastest growth in the G7 – as one of his five missions – promising significantly higher NHS spending too should not be a problem. So if Starmer has faith in his mission to raise growth, he should also say the NHS will benefit greatly from that increased growth.
Starmer stated that “under the last Labour government, nurses were paid fairly and there was no national strike”. That’s true, but the New Labour government increased NHS funding by six per cent per year on average.
Reform is vital, but reform itself has upfront costs – even if it may deliver longer-term savings. Making the case for more NHS funding is unavoidable – and Keir Starmer shouldn’t duck it.
Andrew Fisher is the former director of policy at the Labour Party
